| NPI | 1124397740 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MO 2011035007) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: KS 53-75224-122) |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2013-09-17 |